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Physiological Breech Birth Training Resource Booklet

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Physiological Breech Birth Training Resource Booklet Physiological Breech Birth Training Resource Booklet Shawn Walker, RM PhD & the Breech Birth Network Collective breechbirth.org.uk Contents Physiological Breech Birth Algorithm Nomenclature: Types of Breech ‘Normal for Breech’ – The Mechanisms Complicated Breech Births Evidence Update Building Expertise Photography / Film Agreement Reference List Become a trainer Rights of use: The slides included in this booklet are the copyrighted property of Breech Birth Network, Community Interest Company, and Shawn Walker, RM PhD, unless otherwise indicated. They are provided for personal use only, for those who have attended Physiological Breech Birth Training provided by the Breech Birth Network CIC. No permission is given to copy or distribute the materials. The algorithm and photography/film agreement may be copied and used (CC BY-ND 4.0). E- mail [email protected] for electronic copies. On-line resources can be accessed via the Breech Birth Network Vimeo site. No permission is given to share the site address and password, and any sharing on a public forum would be considered a violation of copyright. Please do use the videos for teaching purposes, but also help us to safeguard the privacy of women and health care professionals who share their vulnerability with us so that others can learn. https://vimeo.com/album/4810021 password: HeadsUp!101 Illustrators Merlin Strangeway – https://www.drawntomedicine.com Kate Evans – http://www.cartoonkate.co.uk Mariamni Plested – https://www.carnelianseeker.com 1 2 © 2018 Breech Birth Network, breechbirth.org.uk Physiological Breech Birth Algorithm Designed by Shawn Walker, RM PhD Steady progress & No interference Reassuring fetal heartrate YES Quiet, calm, warm support between 7 mins Encourage spontaneous Continuous Perineal sweep / NO / not known < maternal movement pushing contractions episiotomy visible on the Breech remains remains Breech perineum Rotation to sacrum ‘Tum to Bum’ Spontaneous anterior begins Sternal crease / birth expected after birth of pelvis cleavage 5 mins Incomplete Running Sweep down anterior arm < diameter) Rotation start (on side baby faces) buttocks buttocks (bitrochanteric Birth of the Birth No rotation – Rotation using flat hands / Release anterior arm Pelvis & shoulders shoulder girdle grip and rotate back remain in A-P diameter 3 mins Fetal head extended at Guide head < Elevate occiput umbilicus pelvic inlet into pelvis & Birth of the Birth & Rotate in A-P diameter realign Fetal head in mid-pelvis Shoulder press, Shoulder press, Rocking or outlet / fingers thumbs fetal head deflexed or delayed below clavicle below clavicle head If not immediately Maternal Lithotomy Scoop & flex forehead Birth of the Birth effective buttock lift / forceps Physiological Breech Birth Algorithm References This algorithm is free to use, provided it is used unchanged and one of the following publications is referenced: Walker S, Parker P, Scamell M (2017) Expertise in physiological breech birth: A mixed methods study. Birth. 45(2):202-209. Re: Breech teams, breech specialists, increasing the rate of vaginal breech birth, generative expertise Walker S, Scamell M, Parker P (2017) Deliberate acquisition of competence in physiological breech birth: A grounded theory study. Women & Birth. 31(3):e170-177. Re: Breech teams, understanding mechanisms, team review of births Walker S, Breslin E, Scamell M, Parker P (2017) Effectiveness of vaginal breech birth training strategies: an integrative review of the literature. Birth. 44(2):101-9. Re: Teaching physiological breech as ‘complex normality’, increasing breech births Walker S, Reading C, Silverwood-Cope O, Cochrane V (2017) Physiological breech birth: Evaluation of a training programme for birth professionals. The Practising Midwife. 20(2): 25-8. Re: Training based on mechanisms, videos, upright birth position Walker S, Scamell M, Parker P (2016) Principles of physiological breech birth practice: A Delphi Study. Midwifery. 43:1-6. Re: Encouraging spontaneous maternal movement, breech teams, breech birth in water Walker S, Scamell M, Parker P (2016) Standards for maternity care professionals attending planned upright breech births. Midwifery. 34:7-14. Re: Manoeuvres used for physiological breech births, maintaining case records, initial resuscitation with umbilicus intact Additional References: Reitter A, Daviss B-A, Bisits A et al (2014) Does pregnancy and/or shifting positions create more room in a woman’s pelvis? Am J Obstet Gynecol 211(6):662.e1-662.e9 Louwen F, Daviss B, Johnson KC, Reitter A (2017) Does breech delivery in an upright position instead of on the back improve outcomes and avoid cesareans? Int J Gynecol 136(2):151–61. 3 Variations of Breech Presentation Frank Breech Hip joints flexed, knees extended Physiological Breech Birth Flexed Breech What is Complete Both hip joints flexed, both knees flexed ‘normal for breech’? Understanding the mechanisms Shawn Walker, RM PhD Incomplete Updated March 2019 Both hip joints flexed, one knee flexed, one knee extended Image by Leah Sandretzky, Closer to my Heart, 2012 ‘Dropped Foot’ in labour One hip flexed, one hip extended Please respect women’s privacy • Do not take photographs of slides which contain pictures Kneeling Breech of women One or both hips extended, one or both knees flexed and presenting • Do not share images on the https://vimeo.com/album/4810021 internet Password: HeadsUp!101 • Informational slides may be Standing / Footling Breech photographed and shared Both hip joints extended, both knees © 2011 Breech Birth Network CIC extended, fetal pelvis not engaged Illustrations by Kate Evans for Breech Birth Network, CIC breechbirth.org.uk 4 5 Physiological Breech Birth Algorithm © 2018 Breech Birth Network, breechbirth.org.uk Different Breech Paradigms Designed by Shawn Walker, RM PhD Steady progress & No interference Reassuring fetal heartrate YES Quiet, calm, warm support 7 mins between between Complex Normality Abnormality perineum contractions visible on the < Breechremains Physiological breech birth has an All breech presentations are observable ‘normal’ mechanisms ‘abnormal’ v Normal = happens >50% of the time, resulting 5 mins diameter) in a spontaneous, healthy birth < buttocks buttocks (bitrochanteric (bitrochanteric “Spontaneous breech birth is of the Birth very rare, usually only preterm” Identifying mechanism helps to (PROMPT 2012) determine when help is needed, 3 mins the the < and when the birth should remain Birth of undisturbed Therefore, assistance to deliver umbilicus the arms and head is routinely applied Requires additional training Birth of the head the © 2011 Breech Birth Network CIC © 2011 Breech Birth Network CIC “Watching Videos” ‘Normal Breech Birth’ P1, previous inducted ND, induction at 38/40 (oligohydramnios) Video 012: ‘Learning Lithotomy’ Video 011 Thank you to the mother © 2011 Breech Birth Network CIC and Delia the Doula for the © 2011 Breech Birth Network CIC use of this video 6 7 A Birth Centre Breech Birth Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center Positive support and preparation in pregnancy Thank you to Midwife A foot has slipped down due to the increased Jennifer Gallardo and the Incomplete breech / Andaluz Waterbirth Center space beneath the sacrum – No need to for the use of these photos ‘Drop-Foot’ Breech © 2011 Breech Birth Network CIC panic! © 2011 Breech Birth Network CIC Optimal hormonal physiology in labour: Rotation The effect of environment is not The breech engages and negligible! descends sacro-transverse Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center for the use of these photos Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center © 2011 Breech Birth Network CIC © 2011 Breech Birth Network CIC 8 9 Both legs are born and the shoulders have descended past the The mother uses ischial spines. a birthing stool to assist the birth. Now gravity is able to do its work, gently bringing the baby down further. This continued progress should be noticeable even between contractions. Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center Thank you to Midwife Jennifer Gallardo and the © 2011 Breech Birth Network CIC Andaluz Waterbirth Center © 2011 Breech Birth Network CIC Baby’s back extends as she is being born to enable the Spontaneous rotation as extended leg to be born the anterior arm drops spontaneously. beneath the pubic arch. Mother leans forward. This This rotation is caused by enables: the head entering the pelvis in the oblique/transverse 1. Baby’s birth to be in line with diameter. the forces of gravity 2. Maximum space in the pelvic outlet as the shoulders Thank you to Midwife descend Jennifer Gallardo and the Andaluz Waterbirth Center Thank you to Midwife © 2011 Breech Birth Network CIC Jennifer Gallardo and the © 2011 Breech Birth Network CIC Andaluz Waterbirth Center 10 11 Rotating back to SA/OA once the head has realigned to occipito- anterior in the pelvis. Baby’s hand slips beside her ear as her face is born. Baby’s left elbow is visible at the introitus. Gravity continues to assist the gradual birth of the head, while Failure to rotate back after birth of midwife’s hands are poised to the anterior arm should alert you to break the fall. a potential problem with the head. Thank you to Midwife Thank you to Midwife Jennifer Gallardo and the Jennifer Gallardo and the Andaluz Waterbirth Center Andaluz Waterbirth Center © 2011 Breech Birth Network CIC © 2011 Breech Birth Network CIC The meaning of a natural Baby appears to be keeping her birth varies from person own head flexed! to person. The chin and the forearm are visible Some women and families behind the cord. value it highly and are strengthened by such a Perhaps a compound presentation birth experience. is only a problem if it causes a delay? In this birth, it seems to be assisting. Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center Thank you to Midwife Jennifer Gallardo and the © 2011 Breech Birth Network CIC © 2011 Breech Birth Network CIC Andaluz Waterbirth Center 12 13 Thank you to Midwife Jennifer Gallardo and the Andaluz Waterbirth Center Baby weighed 4.7 kg.
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